Strategies for adhering to CML treatment with TKIs

Chronic myeloid leukemia (CML) is a cancer where cells in the bone marrow produce large numbers of abnormal white blood cells. These abnormal white blood cells build up in the blood and bone marrow and crowd out healthy cells. A person with CML may experience anemia, infections, bleeding, enlarged spleen, and other serious health problems. This cancer mostly occurs in older adults.

The main treatment for most cases of CML are medications called tyrosine kinase inhibitors (TKIs). These drugs work by blocking proteins called tyrosine kinases. These proteins promote cell growth and division and are found in very high numbers in certain types of cancer cells. Blocking tyrosine kinases helps stop or slow the growth of CML cells.

CML is not considered curable, and the goal of treatment is to put the cancer into remission. Even people who respond well to treatment with TKIs will need to take these drugs indefinitely.

Adherence gives you the best chance of success

To give yourself the best chance of the best possible treatment response, you will need to adhere to your treatment plan as closely as possible.

All TKIs are taken as oral medications, or pills. A person with CML will need to take these medications every day. Oral medications can have advantages over other types of cancer therapies—they are less time consuming than therapies that require infusions and require fewer appointments. However, adhering to an oral medication requires a greater amount of responsibility from the person living with CML.

Taking a pill each day may seem simple in theory, but many people encounter a variety of barriers that prevent them from adhering to their treatment plan. With that in mind, here are some tips and strategies to help with adherence.

Tips and strategies for adhering to an oral cancer medication:

• Have clear instructions from your healthcare provider about how and when to take the medication.
• Set an alarm or reminder on your phone to take the medication. There are also apps that have medication reminders, including apps for some pharmacies.
• Have a backup reminder, such as a note left in a visible place.
• Keep your medication in a designated spot. If possible, it can be helpful to link taking a medication with another routine, such as brushing your teeth.
• Use a pill box that organizes medications into individual doses labeled with the days of the week. If you use a pill box, set a reminder to refill the pill box each week.
• If you have an irregular work schedule or will be away from home when you normally take your medication, have an extra dose or two with you in case you are delayed.
• If you are going to travel, plan ahead for how you will take your medication while away from home.

While the main treatment for CML—and the main focus of this article—are TKIs, chemotherapy is sometimes used in treatment. This includes an oral chemotherapy drug that may be prescribed to lower white blood cell counts or shrink an enlarged spleen. The tips and strategies outlined above can also apply to other oral medications you may need to take to treat CML.

Adherence affects how the cancer responds to treatment. Adherence is an essential piece of information when determining how the cancer is responding to a specific drug, and if you will need to switch to a different drug.

Always be honest with your healthcare providers. If you are having difficulty taking a medication, your healthcare providers need to know as soon as possible.